Understanding and improving the lives of people with OCD

Have you ever worried that you forgot to lock the door on your way out the house, or felt compelled to avoid the cracks in the pavement as you walk down the street? The truth is that as we go through life, many of us will experience obsessive thoughts and compulsive behaviours. For most of us, these feelings are short-lived and don’t interfere with our normal routine. But what happens when they start to disrupt your life, impacting your relationships, your mood and even your physical health?

Obsessive Compulsive Disorder (or OCD) is a chronic anxiety-related condition that is estimated to affect over 740,000 people in the UK alone. OCD Is characterised by two major symptoms – obsessions and compulsions. Obsessions are intrusive, unwanted thoughts or urges that cause distress, anxiety or unease. In contrast, compulsions are behaviours that a person engages in as they try to eliminate their obsessions and decrease their distress. OCD develops when a person becomes trapped in a cycle of obsessions and compulsions and this can have devastating effects on overall quality of life. The World Health Organisation ranks OCD in the ten most disabling conditions of all kinds.

OCD can take on many forms and no two cases are exactly alike. For example, Relationship Obsessive Compulsive Disorder is characterised by unwelcome thoughts about a relationship. In contrast, people with Pure OCD (sometimes referred to as ‘Pure O’) display no outward physical compulsions but are instead consumed by unseen mental rituals and compulsive thoughts.

Across the world, research is providing new insights into the causes of OCD, unlocking the potential for vital new treatments.

We spoke to experts working in the field to find out more…

The complex origins of OCD

With such a complex range of types of OCD, it is perhaps unsurprising that the underlying causes of the condition remain a subject of hot debate. Some believe that compulsive behaviours occur in response to negative thought patterns or faulty beliefs about the world and the way that it works. For example, a person may think they will contract an illness if they don’t wash their hands multiple times before a meal. This explanation is often referred to as the ‘cognitive model’.

Guy Doron, Director of the ROCD research unit at the Baruch Ivcher School of Psychology in Israel, explains how this way of thinking has influenced his understanding of OCD.

“The onset of OCD symptoms is multi-faceted and involves a combination of factors”, describes Guy. “Some factors may be common to most OCD presentations, including general biological predispositions and maladaptive beliefs, whilst other factors may be more specific to particular presentations”.

Guy believes that faulty beliefs may underpin his specific area of research, Relationship OCD. “In Relationship OCD, individuals feel their own worth is dependent on their relationship functioning or the perceived value of their partner. They hold extreme beliefs regarding relationships, for example – ‘if I'm in the right relationship, I must feel euphoric all the time’, or ‘if I get intorelationship I'm not happy in, I won't be able to get out of it”. In this instance, these unwelcome thoughts are likely to contribute towards the onset of obsessions and compulsions in affected individuals.

Whilst the cognitive model has its supporters, recent research suggests that it may not always be the best way to view the origins of OCD.

MQ fellow Dr Claire Gillan is the driving force behind a number of studies investigating the role of habit formation in compulsive behaviour. “Our research focuses on the automatic behaviours that we call habits,” explains Claire. “We’ve done a range of experiments that suggest people with OCD are predisposed to form habits, meaning their behaviour tends to become automatic more readily than it does in those without OCD. We all need to form habits to get through life, but in OCD we see that this process of habit formation gets kicked into overdrive.” Claire and her team believe that this excessive habit formation could actually be the main cause of many cases of OCD.

Claire draws on her personal experiences in the clinic to argue against the idea that people with OCD have a faulty belief system. “Often, when talking to someone with OCD, they can tell you just how irrational they think their behaviour is,” explains Claire. “That is often what makes OCD so frustrating, because people can reflect on their behaviour and say ‘I know that I don’t need to do this ten times’, yet they are unable to override the need to perform these repetitive habits.”

Shining light on the brain circuits involved in OCD

Once repetitive cycles of obsessions and compulsions have been established, how do they get hard-wired in the brain?

Specifically, Susanne investigates whether problems in the brain’s circuits - the networks in the brain responsible for transmitting information - could explain the symptoms of OCD. “OCD patients show increased activity in several regions of the brain,” says Susanne. “However, in people, we have no way of directly testing cause and effect”. Instead, Susanne and her team turned to mouse models and an exciting new technology known as optogenetics, which enables activation of specific circuits in the brain by using short pulses of blue light.

“We targeted a circuit in the mouse brain that is hyperactive in OCD patients,” describes Susanne. “To our surprise, hyperactivation did not directly lead to repetitive behaviours in the mice. However, if we repeatedly stimulated these circuits for multiple days in a row, we saw a progressive development of repetitive grooming behaviours, similar to the compulsive behaviours associated with OCD.” This study suggests that repetitive inputs could be required for the formation of certain symptoms and sheds light on the circuitry of the brain during the earliest stages of OCD.

Using research findings to develop new and improved treatments

Both Claire and Susanne are hopeful that their research can improve the lives of those living with OCD. “If you can understand the mechanisms that cause the symptoms of a disorder, you can intervene more effectively,” explains Claire. “If you know exactly what it is that’s going wrong, you can target that specific factor more accurately using behavioural interventions or medications.”

Susanne is also driven by a desire to improve the lives of those living with OCD. “As a researcher who is supported by public funds, I believe that I have an obligation to constantly be striving towards the goal of the improvement of public mental health,” says Susanne.“The people I really want to help are the patients that I treat. These men and women really bring home the suffering and unrealised potential that can result from psychiatric illness. Their bravery in facing and wrestling with their symptoms is incredibly moving, and I want to do all I can to give them the tools that they need for this battle, be it new medications or new approaches to psychotherapy.”

As we continue to learn about the underlying causes of conditions like OCD, we are able to fine tune strategies of prevention and treatment. Looking forward to the future, there is real hope that we will be able to develop new therapies and alleviate the impact of OCD on the thousands of people living with the condition today.

Last updated: 6 June 2019

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